AAOS Bulletin - December 2006

Health Volunteers Overseas: 20 years as “best of the best”

By Peter Pollack

It’s been the most rewarding aspect of my 32 years of practice,” says Charles D. Jennings, MD, of his experiences with Health Volunteers Overseas (HVO). HVO, which celebrated its 20th anniversary in 2006, is a volunteer organization that sends medical professionals to foreign countries to train local health care providers in modern medical techniques.

Charles D. Jennings, MD, visits with a young patient.

HVO traces its roots back to Orthopaedics Overseas (OO)—a precursor organization that coordinated visits by orthopaedic surgeons to third-world countries for teaching purposes.

The transition from strictly orthopaedics to all medical areas began with a December 1984 article by Ralph Crawshaw, MD, in the Journal of the American Medical Association. Dr. Crawshaw noted the achievements of Orthopaedics Overseas and called for the creation of an organization based on the OO model that would extend into all areas of medicine.

Within two years, OO’s Board of Directors had approved a motion to become the founding division of HVO, which was formally established on Aug. 1, 1986.

Since then, HVO has sent volunteers to 43 countries around the globe. In February 2006, the organization filled its 5,000th volunteer position.

“HVO is a teaching organization,” says Jay S. Cox, MD, who has been involved with HVO for almost 10 years. “Our job is to go over there as individuals and work with the doctors in their environment using the equipment that they have.”

Why go?
Whether on vacation or as a volunteer, most people find that traveling to a third-world country is a major commitment. Travel arrangements can be expensive and complicated, there are health issues such as vaccinations to consider, and cultural and language barriers can be intimidating. HVO assists volunteers with most of the details, but health care professionals are expected to pay their own way. Furthermore, although some volunteer assignments can be completed in a week, most last four to six weeks and occasionally even longer. What could possibly inspire a physician to leave family and practice commitments behind and travel to another country?

For Barry J. Gainor, MD, it’s all about giving something back. “As corny as it sounds, you always receive more than you give,” he says. “There are so many orthopaedic surgeons who are blessed with the gift of their training and knowledge—they have a great talent that they can share.”

Dr. Jennings agrees. “The patients and doctors are extremely grateful, and that’s very rewarding. I feel like you’re doing a good turn for your country in terms of developing relationships with people in these other countries,” says Dr. Jennings. “It gives them a better image of us, and we come to appreciate somebody else’s culture.”

Barry J. Gainor, MD, makes both medical and cultural connections as a volunteer for HVO.

“It’s a wonderful experience, and a way to appreciate your own culture better, as well as to understand other cultures and realize the similarities and differences,” says Richard C. Fisher, MD, who has been involved with overseas teaching programs for more than 25 years. “You really become good friends and colleagues with other orthopaedists around the world, and you realize that these people are really very smart—they’re just in a system that isn’t quite as up-to-date as ours.”

Making progress
Bringing those physicians up-to-date is one of the key elements of HVO. In some countries, practicing orthopaedics is similar to traveling back in time several decades.

“You learn to be imaginative and do things differently than you would back home, where you have different resources available,” explains Dr. Jennings. “But a lot of times, you can rely on the conservative treatment methods that we used for years before all of the fancy stuff came along. For instance, we operate on far fewer fractures in developing countries than we do in the United States. When I was a resident, I’d make rounds on 30 or 40 patients in traction for fractured femurs and fractured tibias. Now, it’s rare that a patient spends any significant amount of time in traction. Yet you go to those developing countries, and fractures are still being treated with traction. You spend a lot of time reviewing at x-rays to make sure the bones are lined up.”

Glen Crawford, MD, discusses an x-ray with eager onlookers.

“You see such different situations. You’ll see dislocations of a shoulder or hip, but the people don’t come in until two or three months afterwards,” says Glen Crawford, MD. “So you have to completely change the way you do things. And then you have to treat them with equipment that you’re not used to using, or it may be antiquated and you have to go back to text books from 30 years ago to figure out how to use it.”

Salvatore J. La Pilusa, MD, a veteran of 12 HVO trips to Vietnam and numerous other countries, says “They have a lot of trauma cases in Viet Nam, because most of the time, the main means of transportation is motorbikes or bicycles. What we usually see there, in one day, we probably don’t see in our hospitals here for over three or four months. We’d get about 15 or 20 severe cases a day.”

Still, for physicians who have become involved with HVO, the progress that is being made is worth all of the challenges.

“Unfortunately, there aren’t a lot of orthopaedic surgeons in some of those countries where HVO gets involved,” says Dr. Cox, “so the people doing the orthopaedics are usually general surgeons and just general medical officers who are learning how to do orthopaedics. For instance, in South Africa, there’s a group that had no formal orthopaedic training, but they’re probably functioning at the level of third-year residents, so they do pretty well.”

“For a long time we had programs in Bangladesh and Indonesia,” says Dr. Fisher. “Those two programs started off with almost no orthopaedists. A full-time person, not from HVO, began the training programs, and we provided instructors every month for years. In both of those countries, they eventually had enough residents graduating to staff their own hospital and various hospitals around the country. Pretty soon, they didn’t need us. It was wonderful.”

An education on both sides
When the final tallies are in, many physicians see working with HVO as something much greater than merely donating time to a charitable organization. They say that the experience has made them not only better surgeons, but better people.

“I believe that all members of the Academy are committed to lifelong learning,” says Dr. Gainor, “which makes volunteering with HVO even more appealing. You can go to lectures, attend instructional courses and watch instructional videos, but there is no educational experience like crossing a border. When you volunteer in a resource-poor nation, you don’t have to fuss with paperwork, insurance, regulations and so forth. It just boils down to you, the patient and caring for the patient’s problem. Even if you have to go down to the machine shop and fashion an external fixator because they have none, then that’s what you do. I find that when I come home from this type of work, I enjoy my patients more.”

“As hard as you think it is to get away from your practice, it’s always possible, and always easier than you think,” says Dr. Crawford. “Your partners will almost always support your decision. It’s a tremendous boon for your patients. When they know that you’ve done something like this, they look at you differently. They know that you’ve spent your time delivering care for absolutely no compensation. I consider it reinvigorating every time I do it. I look forward to it, and even though it’s hard work, it’s still like a vacation because it’s so different from all the hassles we have to deal with here.”

Dr. Gainor agrees. He admits that teaching medicine in a foreign land may not be for everyone, yet he encourages physicians to at least consider it. “The people who do overseas work are the best ambassadors that our country can send abroad. They dispel myths, dismantle prejudices, and, in a world that is inflicted with intolerance, disease and injury, doctors who go overseas are the best of the best.”

For the past 20 years, HVO has helped bring modern medicine to health care professionals in disadvantaged nations. Yet HVO’s influence does not end at the classroom door: volunteers forge personal bonds across borders, and advance cultural understanding and tolerance have been advanced in ways that the even the organization’s founders may not have foreseen. “Rewarding” is the perfect word to describe HVO. May it find continued success in the next two decades.

Learn more

If you are interested in learning more about HVO, check out the organization’s Web site, at www.hvousa.org. The site contains materials and contact information for anyone who is interested in becoming involved as a donor or a volunteer. Be sure to take the time to look at the winning photos in the HVO 20th anniversary photo contest, and consider making a $25 donation to receive a CD of original music, inspired by HVO and performed by Barry J. Gainor, MD.

HVO currently offers orthopaedic programs in the following countries:

  • Bhutan
  • Cambodia
  • China
  • Costa Rica
  • Ethiopia
  • Honduras
  • Malawi
  • Moldova
  • Nicaragua
  • Peru
  • St. Lucia
  • South Africa
  • Uganda

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